| NPI | 1396808275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 43368) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: FL ME146719) |
| 2085B0100X Radiology, Body Imaging (Licence: WI 43368-20) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2021-10-20 |